Donor-Derived Strongyloidiasis Infection in Solid Organ Transplant Recipients: A Review and Pooled Analysis

BACKGROUND

Donor-derived Strongyloides stercoralis infection in solid organ transplant (SOT) recipients is uncommon. Immunosuppressed SOT recipients are at risk of developing severe forms of strongyloidiasis infection through transmission from an infected donor allograft.

METHODS

PubMed was searched for English-written articles published up to April 2015. Articles that reported cases of donor-derived strongyloidiasis infection in SOT recipients were reviewed for a pooled analysis.

RESULTS

A total of 27 cases were identified from various SOT recipients. Donors were mostly from Strongyloides endemic regions (23 cases). No transplant recipients received prophylaxis against strongyloidiasis infection. Median age was 53 years. Median time of presenting symptoms after the solid organ transplantation was 72 days. The most common presenting symptoms were gastrointestinal (GI) symptoms (19 cases; 70.4%). Diagnosis of strongyloidiasis infection was mainly made by the confirmation of Strongyloides larvae or worm in GI samples (19 cases) and respiratory samples (14 cases). Donor-derived strongyloidiasis infection was evidenced by serology test results in 17 cases and epidemiological risk assessment analysis in 10 cases. Ivermectin was the most commonly used medication with use of a combination of iverrmectin and albendazole or thiabendazole in 15 cases. Death was noted in 9 cases (34.6%) of 26 cases with known outcomes. Presence of sepsis or bacteremia was a predictor of mortality because it was seen in 9 patients who died (100.0%) and in 4 patients who survived (23.5%; P < .001).

CONCLUSIONS

Donor-derived strongyloidiasis infection in SOT recipients has high mortality. Effective donor screening and prophylaxis in high-risk SOT recipients may help to decrease morbidity and mortality associated with donor-derived strongyloidiasis.

Risk factors of open converted cholecystectomy for cholelithiasis after endoscopic removal of choledocholithiasis

BACKGROUND

Open converted cholecystectomy could occur in patients who planned for laparoscopic cholecystectomy after endoscopic removal of choledocholithiasis.

AIM

To evaluate the risk factors associated with open converted cholecystectomy.

PATIENTS AND METHODS

The data for all patients who underwent cholecystectomy after endoscopic removal of choledocholithiasis were retrospectively reviewed. Factors predictive for conversion to open cholecystectomy were analyzed.

RESULTS

The rate of open converted cholecystectomy was 15.7 %. In multivariate analysis, cholecystitis (OR 1.908, 95 % CI 1.390-6.388, p = 0.005), mechanical lithotripsy (OR 6.129, 95 % CI 1.867-20.123, p < 0.005), and two or more choledocholithiases (OR 2.202, 95 % CI 1.097-4.420, p = 0.026) revealed significant risk factors for conversion to open cholecystectomy. Analyzing the risk factors for open converted cholecystectomy according to duration from endoscopic stone removal to cholecystectomy (within 2 weeks, between 2 and 6 weeks, and beyond 6 weeks), acute cholangitis (OR 3.374, 95 % CI 1.267-8.988, p = 0.015), cholecystitis (OR 3.127, 95 % CI 1.100-8.894, p = 0.033), and mechanical lithotripsy (OR 17.504, 95 % CI 3.548-86.355, p < 0.005) were related to open converted cholecystectomy in ≤2 weeks group.

CONCLUSIONS

For patients who need cholecystectomy after endoscopic removal of choledocholithiasis, endoscopic retrograde cholangiography-related factors predictive for open converted cholecystectomy are helpful in planning the appropriate timing of surgery.

Risk factors for and clinical implications of mixed Candida/bacterial bloodstream infections

Mixed Candida/bacterial bloodstream infections (BSIs) have been reported to occur in more than 23% of all episodes of candidaemia. However, the clinical implications of mixed Candida/bacterial BSIs are not well known. We performed a retrospective case-control study of all consecutive patients with candidaemia over a 5-year period to determine the risk factors for and clinical outcomes of mixed Candida/bacterial BSIs (cases) compared with monomicrobial candidaemia (controls). Thirty-seven (29%) out of 126 patients with candidaemia met the criteria for cases. Coagulase-negative staphylococci were the predominant bacteria (23%) in cases. In multivariate analysis, duration of previous hospital stay ≥7 weeks (odds ratio (OR), 2.86; 95% confidence interval (CI), 1.09–7.53), prior antibiotic therapy ≥7 days (OR, 0.33; 95% CI, 0.14–0.82) and septic shock at the time of candidaemia (OR, 2.60; 95% CI, 1.14–5.93) were significantly associated with cases. Documented clearance of candidaemia within 3 days after initiation of antifungal therapy was less frequent in cases (63% vs. 84%; p = 0.035). The difference in the rate of treatment failure at 2 weeks was not significant between cases (68%) and controls (62%; p = 0.55). The crude mortality at 6 weeks and survival through 100 days did not differ between the two patient groups (p = 0.56 and p = 0.80, respectively). Mixed Candida/bacterial BSIs showed a lower clearance rate of candidaemia during the early period of antifungal therapy, although the treatment response and survival rate were similar regardless of concurrent bacteraemia. Further studies on the clinical relevance of species-specific Candida-bacterial interactions are needed.

Clarithromycin and amikacin vs. clarithromycin and moxifloxacin for the treatment of post-acupuncture cutaneous infections due to Mycobacterium abscessus: a prospective observational study

An outbreak of post-acupuncture cutaneous infections due to Mycobacterium abscessus occurred in Ansan, Korea, from November 2007 through to May 2008. During this time a prospective, observational, non-randomized study was conducted involving 52 patients that were diagnosed with cutaneous M. abscessus infection. We compared the clinical response between patients treated with clarithromycin plus amikacin regimen and those treated with clarithromycin plus moxifloxacin regimens with regard to time to resolution of the cutaneous lesions. Among the 52 study patients, 33 were treated with clarithromycin plus amikacin, and 19 were treated with clarithromycin plus moxifloxacin. The baseline characteristics for the treatment groups were not significantly different, except for initial surgical excision (n = 27 vs. 6, respectively, p = 0.001). The median time (weeks) to resolution of the lesions in the clarithromycin plus moxifloxacin-treated subjects was significantly shorter than that in the clarithromycin plus amikacin-treated subjects (17 ± 1.1 vs. 20 ± 0.9, respectively, p = 0.017). With adjustments for age, location of lesions, prior incision and drainage, and excision during medical therapy, clarithromycin plus moxifloxacin-treated subjects were more likely to have resolved lesions (hazard ratio, 0.387; 95% confidence interval, 0.165-0.907; p = 0.029). The frequency of drug-related adverse events in the two treatment groups was not significantly different (n = 18 vs. 14, respectively; p = 0.240). The most common adverse event was gastrointestinal discomfort. The results of our study showed that the combination regimen of clarithromycin and moxifloxacin resulted in a better clinical response than a regimen of clarithromycin plus amikacin when used for treatment of cutaneous M. abscessus infection.

A case of pancreatic pseudocyst with an atypical multilocular appearance on endoscopic ultrasound

Pancreatic pseudocysts are focal fluid collections that develop as a result of inflammatory diseases of the pancreas. They are managed conservatively or with a drainage procedure. Their radiological appearance can mimic cystic neoplasms of the pancreas. Pancreatic cystic neoplasms include various neoplasms with a wide range of malignant potential. Here, we report a patient with a pancreatic pseudocyst that presented with macrocystic attributes on endoscopic ultrasound.

Fabrication and characterization of gold-polymer nanocomposite plasmonic nanoarrays in a porous alumina template

A facile, cost-effective, and manufacturable method to produce gold-polymer nanocomposite plasmonic nanorod arrays in high-aspect-ratio nanoporous alumina templates is reported, where the formation of gold nanoparticles and the polymerization of a photosensitive polymer by ultraviolet light are simultaneously performed. Transverse mode coupling within a two-dimensional array of the nanocomposite rods results in a progression of resonant modes in the visible and infrared spectral regions when illuminated at normal incidence, a phenomenon previously observed in nanoarrays of solid gold rods in an alumina template. Finite element full-wave analysis in a three-dimensional computational domain confirms our hypothesis that nanoparticles, arranged in a columnar structure, will show a response similar to that of solid gold rods. These studies demonstrate a new simple method of plasmonic nanoarray fabrication, apparently obviating the need for a cumbersome electrochemical process to grow nanoarrays.

p66Shc expression in proliferating thyroid cells is regulated by thyrotropin receptor signaling

It is almost unanimously accepted that thyrocyte proliferation is synergistically activated by TSH and insulin/IGF-I. Moreover, it was recently suggested that p66Shc, which is an adaptor molecule of the IGF-I receptor, might play a critical role in this synergistic effect. In this study, we undertook to confirm the role and the mechanism underlying the regulation of p66Shc expression via TSH receptor in thyrocytes. We have found that p66Shc expression is elevated in proliferating human thyroid tissues, including adenomatous goiter, adenoma, Graves' disease, and thyroid cancer, but not in normal thyroid. Among growth factors, TSH increased p66Shc expression both in vivo and in vitro; however, IGF-I, epidermal growth factor, or insulin did not. TSH and Graves' Ig increased the p66Shc expression via the TSH receptor-G(s)-cAMP pathway. However, interestingly, IGF-I or epidermal growth factor increased the tyrosine phosphorylations of p66Shc, and this was enhanced by TSH pretreatment. A similar synergism was observed during the DNA synthesis. When we measured the p66Shc levels induced by individual Igs from 130 patients with Graves' disease, TSH receptor stimulating activity and goiter size showed a weak correlation. We conclude that the expression of p66Shc is regulated by signaling through the TSH receptor in proliferating thyroid cells and that p66Shc appears to be an important mediator of the synergistic effect between TSH and IGF-I with respect to thyrocyte proliferation. Moreover, we suggest that TSH potentiates the regulatory effect of IGF-I on thyrocyte growth, at least in part, by increasing the expression of p66Shc.

Malignant mixed müllerian tumor of the ovary: imaging findings

OBJECTIVE

We describe the imaging findings of malignant mixed müllerian tumor (MMMT) of the ovary, which have not previously been reported.

MATERIALS AND METHODS

We experienced 13 cases of ovarian MMMT in eight patients. All patients underwent surgical resection and the MMMTs were confirmed pathologically. US (n = 8), CT (n = 8), and MRI (n = 1) examinations were performed before operation. Imaging features were analyzed retrospectively for bilaterality, tumor solidity (cystic or solid), size, and contrast enhancement of the tumor on CT and MRI. Presence of ascites and other evidence of peritoneal seeding, adjacent organ invasion, distant metastasis, and surgical staging were also evaluated.

RESULTS

There were bilateral ovarian MMMTs in five patients and unilateral MMMTs in three patients. Two of the MMMTs were multiseptated cystic, and 11 were mixed (solid and cystic). The diameter of the largest dimension was less than 5 cm in one case, 5-10 cm in two cases, and larger than 10 cm in 10 cases. Dense homogeneous contrast enhancement of the solid component was seen in 11 mixed masses. Ascites were found in all patients. Other evidence of peritoneal seeding and direct invasion into adjacent organ such as the uterus or sigmoid colon was seen in five patients each. Pleural metastasis was present in one patient. Surgical stages were FIGO classification IIIb and IV in one patient each, and IIIc in six patients.

CONCLUSION

Ovarian MMMTs usually present as aggressive, bilateral, large, solid and cystic tumors, combined with ascites, frequent peritoneal seeding, and adjacent organ invasion.

Diffusion-weighted image and MR spectroscopic analysis of a case of MELAS with repeated attacks

We report the clinical and MR manifestations of an 18 year-old girl with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome. Recurrent status epilepticus caused reversible cytotoxic edema on diffusion-weighted images (DWI). Initial and one month follow-up MR spectroscopy, after seizure control, showed some discrepancies in the ratio of metabolites. N-acetylaspartate (NAA) partially recovered (NAA/creatine (Cr) ratio: 1.27-->1.84). This was because of a normalization of decreased NAA due to cellular dysfunction as a result of status epilepticus. A low ratio of NAA/Cr due to abnormal mitochondria remained in the decreased state. Reversible NAA/Cr ratios in the acute lesion suggested that NAA reflects the neuronal function as well as the level of neuronal structural damage. The altered NAA/Cr ratio better correlated with the abnormal signal intensity area of T2-weighted images (T2WI) and DWI than the lactate (Lac)/Cr ratio. With conservative treatment with anti-epileptics not accompanied by coenzyme Q or sodium dichloroacetate, lactate persistently increased (Lac/Cr ratio: 1.01-->1.21) because of the continued production of lactate in cells with respiratory deficiency, which is the main pathology of MELAS.

Accessing the optical nonlinearity of metals with metal- dielectric photonic bandgap structures

Metals typically have very large nonlinear susceptibilities (~10(6) times larger than those of typical dielectrics), but because they are nearly opaque their nonlinear properties are effectively inaccessible. We demonstrate numerically that a multilayer metal-dielectric structure in which the metal is the dominant nonlinear [chi((3))] material can have much larger intensity-dependent changes in the complex amplitude of the transmitted beam than a bulk sample containing the same thickness of metal. For 80 nm of copper the magnitude of the nonlinear phase shift is predicted to be as much as 40 times larger for the layered copper-silica sample, and the transmission is also greatly increased. The effective nonlinear refractive-index coefficient n(2) of this composite material can be as large as (3+6iota)x10(-9) cm (2)/W , which is among the largest values for known, reasonably transmissive materials.